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Traveler Disclosure and Attestation to the United States of America

All airlines or other aircraft operators covered by the Order must provide the following disclosure and attestation form to all persons intending to board any aircraft destined for the United States from a foreign country and confirm completion of the disclosure and attestation form prior to embarkation.

You must complete this form within 72 hours prior to your flight departing. If you have connecting flights, enter the details of the flight that arrives in the U.S.

If you're completing this attestation on behalf of someone else, fill in your name at the top of the form, then add the name of the person you are attesting for where prompted: 'Name of attestee'. Sign the document in your own name at the end where it says 'Printed name of traveller or authorised representative'.

As required by United States federal law, all airlines or other aircraft operators must, for all travelers on flights departing for the United States from a foreign country, collect and retain for at least 42 days a completed traveler attestation on behalf of the U.S. Centers for Disease Control and Prevention (CDC) and provide the attestation to the U.S. Government upon request. All airlines or other aircraft operators must not board any traveler who has failed to complete and present such an attestation.

 

Each individual must provide a separate attestation. Unless otherwise permitted by law, a parent or other authorized representative should attest on behalf of a traveler under 18 years old. An individual may attest on behalf of another traveler for whom the individual is authorized to submit the required information (for example, adult member of the same traveling party, travel companion, or travel agent). An authorized representative may also act on behalf of any person who is unable to act on their own behalf (e.g., by reason of age, or physical or mental impairment). An airline or aircraft operator employee or agent who assists with data entry or submission at the direction of the traveler or authorized representative does not, solely by providing such assistance, become the authorized representative or provide the attestation on the traveler’s behalf.

 

Under United States federal law, each traveler must present either a printed or digital copy of this attestation. The information provided must be accurate and complete to the best of the individual’s knowledge. Failure to provide this attestation, or submitting false or misleading information, could result in delay of travel, denial of boarding, or denial of boarding on future travel. Any traveler who fails to comply with these requirements may be subject to criminal penalties under, among others, 42 U.S.C. § 271 and 42 C.F.R. § 71.2, in conjunction with 18 U.S.C. §§ 3559 and 3571 (providing for fines and/or imprisonment of up to one year). Willfully providing false or misleading information may lead to criminal fines and imprisonment under, among others, 18 U.S.C. § 1001. The U.S. Department of Justice may seek to prosecute individuals who knowingly and willfully submit false attestations in violation of 18 U.S.C. § 1001.

 

Translations of this attestation approved by CDC will be made available online. In the event of any inconsistency between the English text of this attestation and any translation, the English text controls.

 

プライバシー保護法に関する声明

 

The U.S. Centers for Disease Control and Prevention (CDC) requires airlines and other aircraft operators to collect this information pursuant to 42 C.F.R. §§ 71.20 and 71.31(b), as authorized by 42 U.S.C. § 264. Providing this information is mandatory for all persons arriving by aircraft into the United States. Failure to provide this information may prevent you from boarding the plane. CDC may use this information to help prevent the introduction, transmission, and spread of communicable diseases by performing contact tracing investigations, notifying exposed individuals and public health authorities, and other appropriate public health interventions, including the implementation of travel restrictions.

 

The Privacy Act of 1974, 5 U.S.C. § 552a, governs the collection and use of this information. The information maintained by CDC will be covered by CDC's System of Records No. 09-20-0171, Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigation and Notification under 42 C.F.R. Parts 70 and 71. See 72 Fed. Reg. 70867 (Dec. 13, 2007), as amended by 76 Fed. Reg. 4485 (Jan. 25, 2011) and 83 Fed. Reg. 6591 (Feb. 14, 2018). CDC will only disclose information from the system outside the CDC and the U.S. Department of Health and Human Services as the Privacy Act permits, including in accordance with the routine uses published for this system in the Federal Register, and as authorized by law. Such lawful purposes may include, but are not limited to, sharing identifiable information with state and local public health departments, and other cooperating authorities. CDC and cooperating authorities will retain, use, delete, or otherwise destroy the designated information in accordance with federal law and the System of Records Notice (SORN) set forth above. You may contact the system manager at dgmhpolicyoffice@cdc.gov or by mailing Policy Office, Division of Global Migration Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS H16-4, Atlanta, GA 30329, if you have questions about CDC's use of your data.

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